CYCLOPHOSPHAMIDE-MOBILIZED PERIPHERAL-BLOOD STEM-CELLS IN PATIENTS WITH LYMPHOID MALIGNANCIES

Mobilization of peripheral blood stem cells (PBSC) can be accomplished with cytokines or rebound from myelosuppressive chemotherapy. In this study, patients were mobilized with cyclophosphamide (CY) 4 g/m(2) ei ther alone or followed by GM-CSF 250 mu g/m(2) or G-CSF 600 mu g. Colo ny-stimulating factors were administered subcutaneously, Eligibility i ncluded patients with non-Hodgkin's lymphoma (NHL; n = 29), Hodgkin's disease (n = 4) and acute lymphoblastic leukemia (n = 2), One patient died from mobilization-related complications. Admission for neutropeni c fevers and other complications occurred in 73% of patients receiving CY alone compared with 32% recieved CY + G-CSF or GM-CSF (P < 0.05), Apheresis was initiated when the white blood count approached 1 x 10(9 )/l and continued until approximately 6 x 10(8) mononuclear cells/kg w ere collected, Mobilization with CY + GM-CSF led to significantly grea ter numbers of collected CFU-GM than with CY alone, Colony-stimulating factors were not administered after transplantation, Collected progen itor cells correlated with the peak cell counts after mobilization, Fo llowing transplantation, an ANC greater than or equal to 500 x 10(6)/l was achieved at 14.5 days and a platelet count greater than or equal to 50 x 10(9)/l was achieved on day 20, Days to achieve an ANC greater than or equal to 500 x 10(6)/l did not correlate with any of the anal yzed variables, Platelet engraftment correlated with harvested BFU-E, thawed CD34(+) cells and peak counts following mobilization, For patie nts with NHL, CR was obtained in 82% of evaluable cases, Median time t o relapse was 243 days, Twenty five per cent of patients remain diseas e-free at 900+ days of follow-up, In summary, mobilization with CY is associated with morbidity that could be decreased by administration of colony-stimulating factors, and infusion of collected PBSC leads to r apid engraftment.